Adnexal carcinoma

Typically in the eyelid, face and scalp. They can grow indolently or rapidly. More aggressive than SCCA or basal cell carcinoma

Apocrine carcinoma:

most commonly from apocrine glands of the axilla. Presents as red-purple, single or multinodular, firm or cystic dermal mass in elderly individuals. Because of its rarity, natural history is not well known.

Kaposi’s Sarcoma:

hyper proliferation of endothelial derived spindle cells induced by angiogenic and other factors. Associated with AIDS. Single doses of 8-10Gy or fractionated to 25-30Gy. CR of 70%. Can use chemotherapy including actinomycin D, DTIC, doxirubicin, and VP-16.

Mycosis Fungoides

T cell cutaneous lymphoma

Skin Cancer Syndromes

Basal cell nevus syndrome

Associated with Basal Cell Carcinoma

an inherited group of multiple defects involving the skin, nervous system, eyes, endocrine glands, and bones.

basal cell carcinoma at or about puberty.

Nervous system involvement may include hydrocephalus

wide set eyes

Defects include bones cysts in the upper jaw (maxilla) and lower jaw (mandible)

Epidermodysplasia verruciformis

Associated with Squamous Cell Carcinoma

is a rare, lifelong, viral-mediated, autosomal recessive (Sex-linked and autosomal dominant inheritance patterns have also been reported.) hereditary disorder characterized by

chronic infection with human papillomavirus (HPV).

Widespread skin eruptions of flat-to-papillomatous, wartlike lesions and reddish-brown pigmented plaques on the trunk, the hands, the upper and lower extremities, and the face are characteristic.

Xeroderma pigmentosum

Associated with Squamous Cell Carcinoma and Basal Cell Carcinoma

Cell of Origin

Skins Cancers

Orignal Normal Cell

Basal Cell Carcinoma

Basal Layer

Squamous Cell Carcinoma

Epithelial Layer

Merkel Cell

neuroendocrine, reticular and subcutaneous tissues with sparing of epidermis

Melanoma

melanocytes

Work-up

CT scan used for suspicion for nodal metastases or bone erosion

MRI scan is used for possible nerve involvement in the H/N region.

Biopsy lesion but can surgically excise tumor at the same time.

H/P

Treatment Modalities

Topical chemotherapy: usually 5-Fu for only superficial epidermal lesions.

Surgical excision: if positive margin then can re-excise, RT or observe (if basal cell). Curettage with electrosurgery Electrofulguration and curettage

Cryotherapy: freeze the lesion

Moh's

Advantages

ability to determine if the entire tumor has been removed

only minimal excess normal tissue removed.

Disadvantage

multiple injections of anesthesia and can take up to 2 hours.

Radiation therapy

used for lesions in certain locations where surgery cannot preserve a good cosmetic result

Surgery is typically done for favorable lesions as long as there is not a compromise of function or cosmesis.

RT is typically chosen for lesions larger than 3cm, small lesions near the eyelids/canthus/pinna/nose ala or tip/ upper lip, multiple lesions, alone or in combination with surgery if lesion invades cartilage/bone/nerve.